Essure removal: Experts in removing Essure coils
From January 2008 to May 2014, we performed one hundred and forty-three (143) tubal surgeries to correct either Essure or Adiana sterilization. Of the 143 women who sought treatment from our center, one hundred and thirty-nine (139) had tubal blockage from Essure sterilization and four (4) had tubal blockage from Adiana sterilization.
Of the 139 patients who came for Essure removal, 38 women requested Essure removal because of Essure side effects. None of these 38 women wanted to become pregnant. All surgeries were performed as outpatient procedures at our specialty center.
We maintain extensive statistics on tubal ligation reversal and Essure reversal procedures. We have carefully documented the chances of pregnancy after Essure reversal and we have authored two papers on successful reversal of Essure and Adiana sterilization. It occurred to us after several years we had not devoted enough attention to our Essure removal patients so we decided to conduct an informal follow-up survey with these patients.
Results of our Essure removal study
Readers are encouraged to view the survey study for themselves. This was not a planned prospective study but rather an informal follow-up on patients who had undergone Essure coil removal alone for their symptoms rather than have a hysterectomy.
The information obtained from our survey seems to suggest Essure related symptoms can improve for most after Essure coil removal. Improvement seems to be the most predictable in women who experienced Essure symptoms soon after Essure coils were inserted.
Essure removal study method
All patients who had removal of Essure at our center from 2008 to 2014 were identified from an ongoing database we maintain. To be included patients had to express the primary desire for surgery was for symptoms only and not to become pregnant.
An anonymous email survey was sent to the identified 38 Essure removal patients. One patient had opted out of email surveys and 3 surveys were undeliverable because email addresses were canceled. As a result only 34 surveys were delivered and 24 surveys were returned. The survey response rate was 70%.
Essure Removal data: Survey results
The average age of Essure removal patients was 41. Patients ranged in age from 30 to 56 years of age. All patients had undergone Essure sterilization and were requesting removal of the Essure coils because of abnormal symptoms. The majority of patients complained of increased pain and cramps after Essure insertion. Some patients also complained of skin rash and joint pains.
Although we did not consistently collect information on the date of Essure device insertion when patients came for removal, most patients had the Essure devices inserted within the previous 3 years before seeking Essure coil removal. No patient voiced the desire to become pregnant as the reason for having Essure coils removed.
Procedure to remove Essure coils
At our facility we allow our patients to choose the surgical procedure they feel is best procedure for them.
We counsel our patients who are having symptoms after Essure sterilization to have coil removal alone and bilateral tubal ligation. We believe this is the best procedure to provide symptom relief and to minimize the risk of unintended pregnancy.
Some of our patients would like their tubal anatomy restored to normal after the coils have been removed. As a result of their desires, we also offer patients having Essure removal bilateral tubotubal anastomosis (rejoining the tubes after the Essure coils have been removed) and bilateral tubal implantation (reinserting the tubes back into the uterine cavity after Essure coils have been removed).
Our recommendation to patients who want their Essure coils removed because of symptoms is to have a simultaneous tubal ligation at the time of coil removal to treat symptoms but not risk becoming pregnant. Any pregnancy after tubal surgery increases the risk of ectopic (tubal) pregnancy.
Of the 38 patients who had Essure removal, 17 (45%) had bilateral tubal occlusion (tubal ligation), 15 (39%) had bilateral tubotubal anastomosis (rejoining of tubes), and 6 (16%) had bilateral tubal implantation (reinsertion of tubes) procedures.
Of the 38 patients who came for coil removal 36 had coils in the proper anatomical location and 2 patients who came for removal within 3 months of insertion were found to have ectopic Essure coils. One patient had coil migration within the uterine cavity and another had coil migration into the abdominal cavity (omentum).
Essure removal complications
Complications were defined as immediate and delayed. An immediate complication was defined as any patient who required hospitalization for any reason at the time of surgery. A delayed complication was defined as any surgical site infection or unanticipated doctors visit within the first 30 days of Essure removal surgery at our facility.
We did not experience any immediate complications after Essure removal. One patient developed a subcutaneous hematoma (blood clot underneath the incision) within the first week of surgery and this was safely drained without major surgery.
Complications were identified before discharge and by calling patients by phone within the first 2 days after surgery and after discharge by emailing patients 30 days of surgery. Results of Essure removal were evaluated using an anonymous survey sent by email. Patients were sent the survey an average of two years after removal surgery (range 4 years to 3 months). The survey response rate was 70%.
Essure removal results
Most patients (53%) sought Essure removal in order to avoid a hysterectomy. The vast majority of respondents, 23 patients (96%), reported they were seeking Essure removal for treatment of abnormal symptoms. Respondents reported many symptoms but the most common were abnormal bleeding and pain. The symptoms started within weeks of having the Essure coils inserted and most rated the severity of their symptoms a 7.5 out of 10.
The majority of respondents, 22 patients (92%), reported their symptoms improved after Essure coil removal and 8% (2 patients) reported not improving or becoming worse. The majority of patients, 83% (20 patients), reported not needing any additional treatment for symptoms after surgery and 4% (1 patient) reported having a hysterectomy. No patient reported becoming pregnant after surgery.
Essure removal works
If they were allowed to make another decision about how they wanted to deal with possible Essure symptoms 21 patients (88%) reported they would choose Essure coil removal again rather than hysterectomy 2 patients (8%) reported they would have opted for a hysterectomy and 1 patient (4%) responded they would not have had surgery.
When asked if they felt Essure coil removal alone helped their symptoms 21 patients (91%) reported they felt Essure coil removal alone helped them with their symptoms.
It is also notable that only 18% of patients reported taking hormones after Essure removal but over 90% of all patients reported improvement in their symptoms. Often hormones can mask underlying issues and may be the reason patients see improvement in their symptoms but in this small survey most women did not take hormones after removal. This supports the fact the Essure coils alone were likely responsible for many of the patient’s symptoms.
Admittedly this is a small study and we don’t know what the non-responders have to say. It is encouraging most patients felt the surgery helped them and the average time since surgery was 2 years.